Hip and pelvic fractures can be complex injuries, and NYU Langone doctors often perform surgery to reduce the fracture, stabilize the bone, and repair soft tissue structures. If a fracture severely affects the function of the hip, a surgeon may recommend replacing the injured joint with long-lasting prosthetic parts.
The goals of surgery are to minimize pain, restore hip function, and allow you to return to your everyday routine. Orthopedic doctors at NYU Langone have specialized expertise in hip surgery. They determine the appropriate surgical procedure based on your age, the location and severity of the injury, the cause of the fracture, and whether underlying medical conditions—such as osteoarthritis or osteoporosis—might affect the outcome.
A broken bone in the hip or pelvis needs to be set and stabilized in order to heal fully. Reduction is the process of setting the bone or reassembling the bone fragments. Fixation is a procedure used to prevent bone fragments from moving while new bone tissue grows, and fuses the pieces into one solid bone.
Depending on the location and severity of the fracture, a surgeon may perform an open or closed reduction.
In a closed reduction, a less invasive procedure, the surgeon makes small incisions near the broken bone and uses surgical instruments to reassemble the bone fragments. Closed reduction may be appropriate for simple fractures that don’t involve many bone fragments and haven’t broken the skin. A closed technique may minimize damage to surrounding soft tissues and speed healing.
In an open reduction, the surgeon makes an incision over the injured area to view the pieces of broken bone and assess how well they can be put back together. Open reduction is required for open fractures, in which a bone breaks through the skin. This technique is also needed when fractured bones have broken into many pieces, some of which are displaced, or out of position. Open reduction is used if bone fragments are so small that they need to be removed. Doctors may need to perform this procedure if they weren’t able to reassemble bone fragments in the correct position during a closed reduction.
Because the acetabulum, or hip socket, is located behind the leg bone and therefore is difficult to access, any fracture in this part of the pelvis requires an open reduction.
After the fractured bone has been reduced, a surgeon uses one or more fixation devices to keep the bone fragments in position while the bone heals. Most of the time, surgeons use internal fixation, a technique involving stainless steel screws, plates, wires, and rods to permanently fix the bone fragments together.
The surgeon determines the most appropriate fixation device depending on the location and severity of the fracture.
If a fracture occurs as the result of a traumatic, life-threatening accident, such as a car crash, a surgeon may stabilize the bone with an external fixation device. This allows doctors to focus on repairing internal organs, blood vessels, and nerves. Later, surgeons may perform additional procedures to permanently fix the bone fragments in place.
In external fixation, surgeons insert metal pins into the bones on each side of the hip or pelvic fracture, then connect those pins to a frame that extends outside the body. This frame joins together any displaced pieces of bone and keeps the bones stable.
This type of external brace is used only for fractures accessible from the front of the body. A fracture at the rear part of the pelvis requires surgery using alternative fixation techniques.
If a hip or pelvic fracture has compromised the hip joint so much that reduction and fixation don’t stabilize the bones, doctors may recommend a procedure to replace the injured ball and socket components of the joint with durable prosthetic parts, usually made from metal or ceramic. Partial or total hip replacement is more often recommended for people with serious fractures of the femur not amenable to fixation.
Prior to surgery, you are given spinal or general anesthesia. The surgeon makes an incision along the front, side, or back of the hip to reach the hip joint. He or she removes the round femoral head and the damaged surface of the socket-shaped acetabulum, as well as loose pieces of cartilage or other tissue.
The surgeon then puts the prosthetic parts in place and closes the incision with stitches. Doctors inject pain medication into the surrounding tissues of the hip to help control discomfort after the procedure.
As soon as you are capable, NYU Langone physical therapists help you stand and walk. The goal is to maintain strength in your muscles and joints and increase blood flow to the hip and leg, which may speed your recovery.
Physical therapists monitor healing and help you walk with your new hip. Pain management specialists prescribe medication to ensure you’re comfortable while your body heals.
You may go home as soon as you are mobile enough to perform daily activities on your own. That may be the same day as the surgery or one to three days later, depending on how quickly you recover.
After you can walk unassisted and without pain, NYU Langone physical therapists help you rebuild muscle and teach you exercises to increase the flexibility and range of motion in the hip. Our rehabilitation doctors and physical therapists create an exercise routine that you can perform at home to condition and strengthen your muscles. Our doctors usually prescribe physical therapy for 6 to 12 weeks. Afterward, they assess your progress to determine if additional physical therapy is needed.
Most people return to the hospital or a doctor’s office for a follow-up examination two to four weeks after surgery. Crutches, a cane, or a walker are usually required for two to four weeks.
Today’s joint implants are made with more durable materials than in the past, and the majority of prosthetic hip replacements last for 20 years or more. After 20 years, a small number of joint implants wear out and may need to be replaced.
Our doctors recommend annual or biannual appointments after surgery, so that our specialists can ensure your hip implant continues to perform well and without complications.
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